Healthcare Provider Details

I. General information

NPI: 1306852603
Provider Name (Legal Business Name): ADEKEMI OLASOJU OGUNTALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 HICKEY BLVD FL 2
DALY CITY CA
94015-2770
US

IV. Provider business mailing address

395 HICKEY BLVD FL 2
DALY CITY CA
94015-2770
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-4575
  • Fax: 650-301-4475
Mailing address:
  • Phone: 650-301-4575
  • Fax: 650-301-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA79284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: